P278 THIOPURINES AND ANTI-TNFS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE AND A POSITIVE HISTORY OF CANCER

Background

Whether patients with Inflammatory Bowel Disease (IBD) and a positive history of cancer may be treated with immunomodulators is undefined. In a retrospective cohort study, the outcome of IBD patients treated with immunosuppressors (IS: thiopurines, methotrexate and/or cyclosporine) and/or anti-TNFs after a diagnosis of cancer was evaluated.

Methods

Clinical characteristics of all IBD patients in follow up at our tertiary IBD center from 2000 to 2013, with a diagnosis of cancer were reviewed. Among IBD patients with a history of cancer, the subgroup treated with IS and/or anti-TNFs after the diagnosis of cancer were included. Parameters considered: 1.IBD type (Crohn's Disease,CD vs Ulcerative Colitis,UC); 2. Gender; 3. Age at diagnosis of IBD; 4. Age at diagnosis of cancer (yr); 5. IS or anti-TNFs (Infliximab, IFX, Adalimumab, ADA) use; 6. IBD duration at time of diagnosis of cancer; 7. Time interval between diagnosis of cancer and IS or anti-TNFs use; 8. Follow up duration after the diagnosis of cancer; 9. Characteristics of cancer. Data were expressed as median (range).

Results

In the 13 years follow up, 82 IBD patients had a history of cancer. Among these 82 patients, 15 (18.2%) were treated with IS after the diagnosis of cancer. These 15 patients included 12 CD and 3 UC (8M; age at diagnosis of cancer 41,range 21-69; age at diagnosis of IBD 27,range 12-66, IBD duration at diagnosis of cancer 10, range 1-38). After the diagnosis of cancer, 12 were treated with IS (AZA 8; 6MP 4), 3 with anti-TNFs (ADA 2;IFX 1). Cancer in these 15 patients involved: thyroid (n=4), skin (NMSC n=2; 1 basal cell carcinoma, 1 spinal cell carcinoma); breast (n=2), colon (n=2), prostate cancer (n=2) lymphoma (HL n=1), seminoma (n=1), appendiceal carcinoid (n=1). The time interval between the diagnosis of cancer and IS or anti-TNFs use was 6 years (range 1-26). After a median of 10 years (range 3-30) from the diagnosis of cancer, none of the 15 patients treated with IS or anti-TNFs after the diagnosis of cancer showed recurrence or new onset of cancer. No cancer-related deaths were observed, and only 1/15 patients had a cirrhosis-related death.

Conclusion

In a retrospective study, the use of thiopurines or anti-TNFs did not appear to worsen the outcome of IBD patients with a positive history of cancer. Larger prospective longitudinal studies are needed to further address this relevant issue in IBD.